Journal of pain and symptom management
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J Pain Symptom Manage · Mar 2000
Comparative Study Clinical TrialTransdermal fentanyl in opioid-naive cancer pain patients: an open trial using transdermal fentanyl for the treatment of chronic cancer pain in opioid-naive patients and a group using codeine.
To treat cancer pain, physicians often decide to jump directly from step 1 of the World Health Organization (WHO) analgesic ladder to step 3. The use of transdermal fentanyl in patients with cancer pain who had either used no opioid before, or only codeine, is evaluated in the present trial. Both opioid-naive (N = 14) and codeine-using (N = 14) patients started with transdermal fentanyl in the lowest available delivery rate (25 microg/hr). ⋯ The common side effects of opioids were found; constipation was mentioned by 3 patients (11%). Transdermal fentanyl appeared a safe analgesic in these opioid-naive cancer pain patients. In this study, WHO step 2 could be skipped without untoward complications.
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J Pain Symptom Manage · Mar 2000
Clinical TrialDemographic, symptom, and medication profiles of cancer patients seen by a palliative care consult team in a tertiary referral hospital.
In this retrospective study, the charts of 100 consecutive cancer patients who had been referred to a palliative care consult team within a tertiary acute care hospital were reviewed. Demographic characteristics, including reason for admission and disease status upon admission, length of stay, and discharge and admission location, were recorded. Symptom acuity, cognitive status, and risk for substance abuse were evaluated. ⋯ Eighty-nine of the 95 patients were living at home prior to admission and 34/95 were able to return home. Twenty died during hospitalization, 23 were transferred to a palliative care unit, and the remaining 18 were discharged to another hospital or long-term care. The patient's physician complied with the palliative care consult team's recommendation in 122/137 cases (89%).
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J Pain Symptom Manage · Mar 2000
Clinical TrialA prospective study of catheter-related complications of intrathecal drug delivery systems.
Intrathecal drug administration via implanted pump is an effective treatment for intractable pain and spasticity but can be compromised by catheter-related complications. To determine the etiology of catheter-related complications, we have conducted a multicenter, prospective study of the long-term performance of a one-piece catheter system. Data pertaining to catheter-related complications were collected at implant and at specified times during the follow-up period. ⋯ The 9-month complication-free "survival" rate was 78.9% overall (95.5% for the catheter itself). No specific catheter implantation characteristics were associated with the occurrence of complications. These data indicate that the incidence of complications for a one-piece catheter system is similar to that of commercially available two-piece systems, and highlight the need for careful surgical technique during implantation.
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Driving has been regarded as an activity of daily living that is important in maintaining a person's independence in the community, access to employment, and social activities. Many patients, however, using opioid medications on a regular basis (Chronic Opioid Analgesic Therapy: COAT) to ameliorate their intractable pain have been restricted from driving out of concern that skills would be impaired and driving safety compromised by these medications. Yet there are no driving studies which have explored the effects of using opioid analgesics for an extended period of time. ⋯ Notably, COAT patients had a relatively poorer performance than CComp patients on specific neuropsychometric tests in the PDE; however, the differences were not statistically significant and did not imply a systematic pattern of scores that reflected domain-specific deficits. Behaviorally, COAT patients were generally superior to CComp patients, also; however, COAT patients had greater difficulty in following instructions and as well as a tendency toward impulsivity, like the BTW fail group. While there was general support for the notion that COAT did not significantly impair the perception, cognition, coordination, and behavior measured in off-road tests that have been regarded as requisite for on-road driving, methodological problems may limit the generalizability of results and recommendations are made for research beyond a pilot study.
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J Pain Symptom Manage · Mar 2000
Clinical TrialRegulatory and educational initiatives fail to promote discussions regarding end-of-life care.
We conducted an observational cohort study to determine if hospital-based, reinforcing regulatory and educational interventions could encourage physicians to discuss end-of-life (EOL) care with their patients. Specifically, we measured the effect of (1) administrative prompts to encourage discussions about EOL care and (2) a mandatory educational seminar focusing on EOL issues. Study subjects were patients consecutively admitted to the medicine service who faced an anticipated 3-year mortality rate of at least 50%. ⋯ In the inception cohort of 184 patients, physicians discussed EOL care with 64 patients (34. 8%), and in the follow-up cohort of 121 patients, 41 individuals (33. 9%) had documented discussions regarding EOL issues (P = 0.90). Actual "Do Not Resuscitate"(DNR) orders were written for 53 patients (28.8%) in the inception cohort and for 33 persons (27.3%) in the follow-up cohort (P = 0.71). We conclude that enhanced, mutually reinforcing regulatory and educational efforts focusing on EOL care proved ineffectual at promoting either discussions about EOL issues or the use of DNR orders.